Date set for largest-ever healthcare fraud case

A trial date has been set for a south Florida businessman accused of a $1 billion Medicare and Medicaid fraud scheme spanning 14 years.

A Miami federal judge scheduled Philip Esformes’ trial for Sept. 18, 2017. Esformes, 48, pleaded not guilty to charges of conspiracy, obstruction, money laundering and health care fraud involving numerous Miami-based health care providers. If convicted, he faces a potential life prison sentence.

“This is the largest single criminal health care fraud case ever brought against individuals by the Department of Justice, and this is further evidence of how data-driven law enforcement has been as a tool in the ongoing fight against health care fraud,” said Assistant Attorney General Leslie R. Caldwell in a Department of Justice press release.

Esformes, along with his father, Morris Esformes, own the Lincolnwood, Illinois-based Esformes Network of more than 30 skilled nursing homes and assisted living facilities. The federal indictment alleges Esformes, a hospital administrator and a physician’s assistant ran 14,000 Medicare and Medicaid patients through Esformes Network facilities despite being unqualified for admittance. There, beneficiaries received unnecessary or even harmful treatments that were billed to Medicare and Medicaid.

The indictment also alleges drug addicts were lured to the facilities with promises of narcotics. Some allegedly received OxyContin and fentanyl without a physician's order so they would stay.

Esformes and his conspirators paid kickbacks to health care regulators and medical professionals and received kickbacks for steering patients to other health centers, including community mental health centers and home health care providers who also performed and billed for unnecessary treatments. Kickbacks were often paid in cash or disguised as payments to charitable donations, payments for services and sham lease payments, court documents allege.

Nicole Stempak

Nicole was Senior Editor at I Advance Senior Care and Long Term Living Magazine 2015-2017. She has a Journalism degree from Kent State University and is finalizing a master’s degree in Information Architecture and Management. She has extensive studies in the digital user experience and in branding online media. She has worked as an editor and writer for various B2B publications, including Business Finance.